Kuan-Yang Chen

Hybrid vs sequential therapy for eradication of Helicobacter pylori in Taiwan: A prospective randomized trial.

AIM To evaluate the efficacy of sequential vs hybrid therapy in patients with Helicobacter pylori (H. pylori) infection. METHODS From March 2013 to May 2014, one hundred and seventy-five H. pylori infected patients who had not been treated for H. pylori before were randomized to receive either sequential therapy (rabeprazole 20 mg and amoxicillin 1 g twice daily for 5 d, followed by rabeprazole 20 mg, clarithromycin 500 mg and metronidazole 500 mg twice daily for 5 d) or hybrid therapy (rabeprazole 20 mg and amoxicillin 1 g for 7 d, followed by rabeprazole 20 mg, amoxicillin 1 g, clarithromycin 500 mg and metronidazole 500 mg twice daily for 7 d). H. pylori status was confirmed by positive results of both rapid urease test and histology examination or a positive result of culture. Eradication efficacy was assessed by follow-up endoscopy with rapid urease test and histological examination 8 wk after the end of anti-H. pylori therapy, or (13)C-urea breath test at least 4 wk after completion of treatment. The primary outcome was H. pylori eradication by intention-to-treat (ITT) and per-protocol (PP) analyses. RESULTS One hundred and sixty-seven patients (83 patients in the sequential group and 84 patients in the hybrid group) completed the study. The compliance rates were 97.6% and 97.7% for the two groups, respectively. The eradication rate was 78.2% for the sequential group and 92% for the hybrid group by ITT analysis (P = 0.01). The eradication rate was 81.9% for the sequential group and 96.4% for the hybrid group by PP analysis (P = 0.01). Univariate analysis for the clinical and bacterial factors did not identify any risk factors associated with treatment failure. Severe adverse events were observed in 2.3% of patients in the sequential group and 2.4% of those in the hybrid group. CONCLUSION Due to a grade A (> 95%) success rate for H. pylori eradication by PP analysis, similar compliance and adverse events, hybrid therapy seems to be an appropriate eradication regimen in Taiwan.

Performance of Routine Helicobacter pylori Invasive Tests in Patients with Dyspepsia

Background. This study was designed to compare the accuracy of three different invasive methods for the detection of Helicobacter pylori (H. pylori) infection in patients with dyspepsia. These tests included culture, histology, and the rapid urease test (CLO test). Methods. H. pylori infection was diagnosed prospectively in 246 untreated dyspeptic patients who underwent upper gastrointestinal endoscopy. The gold standard for H. pylori infection was based on a positive culture or both a positive histological examination and a CLO test. Results. H. pylori was diagnosed in 33.3% of the patients. The sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy were as follows: histology from the antrum (95.12; 95.12; 90.7; 97.5; 95.12%); histology from the antrum and corpus (95.12; 95.12; 90.7; 97.5; 95.12%); histology from the corpus (76.83; 96.95; 92.65; 89.33; 90.24%); culture (91.46; 100; 100; 95.91; 97.15%); a CLO test from the antrum and corpus (85.59; 100; 100; 93.71; 95.52%); a CLO test from the antrum (64.63; 100; 100; 84.97; 88.21%); a CLO test from the corpus (69.51; 100; 100; 96.77; 89.83%), respectively. Conclusions. Antral biopsy histology and culture are the best methods for the diagnosis of H. pylori infection in our cohort of patients with dyspepsia.

Percutaneous radiofrequency ablation of liver malignancies

OBJECTIVE To describe the safety and efficacy of percutaneous radiofrequency ablation (PRFA) to treat liver cancer. METHODS One hundred patients with histologically or clinically confirmed primary or metastatic malignancies were treated percutaneously under ultrasound guidance using LeVeen multipolar array needle electrode and RF 2000 generator between October, 1999 and October, 2000. All patients were followed up to assess complication, treatment response, recurrence and curative effect. RESULTS PRFA was performed in 76 patients with primary liver cancer and 24 patients with metastatic liver cancer. AFP positive of small hepatic cancer (inoperative) became AFP negative in 75.0% patient (21/28). The rate of completely concrete necrosis of small hepatic malignancies shown by MRI was 85.9%(61/71). CONCLUSIONS PRFA as a local thermal therapy is a kind of new palliative treatment for hepatic malignancies. It is minimally invasive, safe and effective especially for small hepatic tumors and can also be used in conjunction with TACE for larger ones.

Risk factors for 1-year mortality in patients with intermediate-stage hepatocellular carcinoma treated solely with transcatheter arterial chemoembolization

Transcatheter arterial chemoembolization (TACE) is a main therapy for patients with intermediate‐stage hepatocellular carcinoma (HCC). The purpose of our study was to determine the risk factors for 1‐year mortality in patients treated solely with TACE.

Fuzzy residual statics computation

The essential information needed for residual statics computation is the normal-moveout-corrected event times. Because of the noisy nature of seismic data, picking the event times is a difficult task. Our approach is to describe the event times implicitly in terms of fuzzy sets. As a result, we can delay picking of event times until a stage in which they are easier to determine. The benefits are that we minimize the chance of throwing out needed information and avoid making erroneous picks for later computations. We define a fuzzy averaging operation and extend a well-known back-projection algorithm in a fuzzy context that allows us to compute a set of fuzzy statics. We then defuzzify this set of fuzzy statics to crisp numbers and apply them to correct seismic data, Our results show the robustness of this algorithm for noisy data with large residual statics.

CYP2C19 polymorphism has no influence on rabeprazole-based hybrid therapy for Helicobacter pylori eradication

AIM To evaluate the impact of cytochrome P450 2C19 (CYP2C19) and interleukin-1β (IL-1β) polymorphisms on the efficacy of Helicobacter pylori (H. pylori) eradication by using rabeprazole-based hybrid therapy. METHODS A total of 88 H. pylori-infected patients were recruited to receive 14-d of hybrid therapy from March 2013 to May 2014. Three patients were excluded from analysis because of incomplete compliance. Either a follow-up endoscopy or 13C-urea test was performed to determine the results of H. pylori eradication therapy. The genotypes of CYP2C19 and IL-1β were analyzed to investigate the impact on treatment effect. RESULTS The total eradication rate of H. pylori was 92.94% (79/85). According to the CYP2C19 genotypes, the rates of H. pylori eradication were 89.19% in extensive metabolizers (EM) and 95.83% in non-EM. The H. pylori eradication rates regarding the IL-1β genotypes were 92.59% in the normal acid secretion group and 93.10% in the low acid secretion group. After multivariable logistic regression analysis, both the genotypes of CYP2C19 and IL-1β had no significant influences on the eradication rates of H. pylori. CONCLUSION The CYP2C19 and IL-1β polymorphisms are not significantly independent factors of H. pylori eradication using rabeprazole-based hybrid therapy.

Undifferentiated embryonal sarcoma of the liver in an adult: Case report and literature review

Undifferentiated embryonal sarcoma of the liver often presents in the childhood. Its occurrence rate in adults is extremely low. A 70‐year‐old woman suffered from right upper quadrant abdominal pain, fever, and body weight loss of 10 kg over half a year. Abdominal ultrasonography and computed tomography revealed one 9‐cm tumor with a cystic component at S6/S7 of the liver. The tumor markers, such as serum alpha‐fetoprotein, carcinoembryonic antigen, and carbohydrate antigen 19‐9, were in the normal range. Repeated biopsies showed no malignancy. After exclusion of infectious diseases through an inflammation scan, she underwent S6/7 bisegmentectomy. The final report of pathology was undifferentiated embryonal sarcoma. No evidence of recurrence or metastases was noted during follow‐up visits. The rate of misdiagnosis before operation is high. The enhancing of radiological feature‐reading skills and clinical awareness are considered to be necessary to reduce misdiagnosis. The prognosis was considered to be poor before. Multimodal treatment with complete surgical excision and chemotherapy provided the best chance of long‐term disease‐free survival. We concluded that undifferentiated embryonal sarcoma should be included in the differential diagnostic list of malignant liver tumors in adults.

Sigmoid colonic endometriosis mimicking colon cancer: A case report

Endometriosis is common in women of reproductive age, which can involve the intestinal tract. However, large bowel obstruction is an extremely rare complication of colonic endometriosis. In this article, we present a case of intestinal endometriosis with the symptom of rectal bleeding in the menstrual period for 1 year. Colonoscopy showed a semicircular tumor with luminal narrowing at rectosigmoid junction. The pathology of biopsy specimen revealed endometrial glands by repeated check after reviewing the patients history. Surgical resection was performed because of luminal stricture. Intestinal endometriosis should always be kept in mind as a differential diagnosis in reproductive‐aged female patients who have symptoms of gastrointestinal bleeding and abdominal pain in the menstrual period.

CYP2C19 polymorphism has no influence on rabeprazole-based sequential therapy

The aim of this prospective study was to evaluate the impact of cytochrome P450 2C (CYP2C19) and interleukin‐1β (IL‐1β) polymorphisms on the efficacy of Helicobacter pylori (H. pylori) eradication by using rabeprazole‐based sequential therapy.

Risk Factors of Upper Gastrointestinal Bleeding in Patients Hospitalized in a Chronic Ward

Objectives: Upper gastrointestinal (UGI) bleeding is one of the most frequent complications among patients who need long-term care in a chronic ward. In this retrospective study, we therefore investigated the characteristics of UGI bleeding among patients hospitalized on a chronic ward. Methods: A total of 173 patients admitted to the chronic ward of the Ren-Ai Branch, Taipei City Hospital, were retrospectively enrolled. These individuals consisted of 109 patients with UGI bleeding and 64 patients without UGI bleeding. The demographic data and clinical courses of these patients were compared. Results: There were 135 (78.0%) patients who needed long-term naso-gastric (NG) tube feeding. Patients with UGI bleeding had a significantly higher rate of NG tube placement than those without UGI bleeding (89.9% vs. 57.8%, p＜0.001). All 12 patients with uremia suffered from UGI bleeding. In addition, the presence of a NG tube (odds ratio, 6.19; 95% CI, 2.69-14.21, p＜0.001) and the presence of diabetes mellitus as a comorbidity (odds ratio, 2.63; 95% CI, 1.16-5.96, p=0.021) were independent risk factors associated with UGI bleeding. A total of 75 UGI bleeding associated lesions were observed among 53 patients who underwent upper gastrointestinal endoscopy. Esophagitis or an esophageal ulcer was the most frequent causes of UGI bleeding (36%). The overall mortality rate was 50.3%. However, only 3.5% of the patients died from uncontrolled bleeding. Conclusions: UGI bleeding occurs frequently in patients with chronic illness. The presence of a NG tube, uremia as a comorbidity and diabetes mellitus as a comorbidity were found to be risk factors associated with UGI bleeding. The most common source of UGI bleeding in patients who were undergoing NG tube feeding was esophagitis and/or esophageal ulcer.